Just Joslin - September 2018

Just Joslin | September Edition

With the start of school and the end of the “lazy days” of summer, September is a good time to get back into routine. In this edition of Just Joslin, we share the importance of routine blood glucose monitoring and tips for overcoming barriers.

Speaking of barriers, many people find it difficult to start exercising because they can’t overcome the vision of what they feel exercise should be. This month’s activity piece provides some fun, alternative ways to help you reach your movement goals.

Finally, although it isn’t included in the activity list, apple picking is a favorite this time of year and we have the perfect recipe for your pickings.

Side note for our southern Illinois readers: Be sure to check out the information about our new telehealth service – because distance should not be a barrier to care and education.

~Melissa Schutz, MS, RD, LDN, CDE

Tips for Routine Monitoring

Routine monitoring of blood sugar levels is a crucial step in diabetes management. Continuous glucose monitors may make it easier to obtain results. However, these devices may not be an option for everyone and there are differences in device capabilities. It is important to speak with your health care provider about your options. In the meantime, let’s address some of the top barriers to routine monitoring that we hear as educators and some alternate site testing.

Top Barriers

My fingers are sore from poking so much.

Make sure you are changing the lancet (needle) each time you test. Lancets have a lubricant on them that begins to come off after the first use. Therefore, each consecutive poke may hurt more.

Make sure you are rotating which fingers you are using and that you are using each side of the finger pad.

Consider using alternate sites for testing if your meter is compatible. See the “Alternate Site Testing” section below for important information and guidelines.

I don’t want to see the results because I feel guilty or depressed if they are high.

For your healthcare team, your results are simply a means to help identify a potential need for treatment changes. Without these results, it is difficult to accurately troubleshoot if medications need adjusted or if diet and/or activity could lead to improvement. If results don’t seem accurate, consider the age of your meter. Accuracy can decline over time so it may be time for replacement.

The results were always the same so I stopped checking.

Routine monitoring can lead to increased awareness of your blood sugar trends. If there is no change, that can be a great sign that your body is healthy and your treatment plan is working as it should. On the other hand, a change in these trends may be the first sign that your treatment plan needs adjusted or that your body is trying to signal something is wrong, such as infection. Finally, checking blood sugar at alternating meals, bedtime, or 2 hours after a meal may lend some variety in results as well as help troubleshoot reasons for the variety. Speak with your healthcare provider before changing your routine.

I didn’t have my meter with me when it was time to check.

Consider obtaining a second glucose meter to take with you when you are away from home. An extra meter may also be helpful to have in different parts of your house, such as in the kitchen to test before meals and at your bedside to test at bedtime. Important tips: Keep all results from each meter in one log book and take this or each meter to your appointments so your healthcare provider is able to see all results. Don’t leave the extra meter in a hot or cold vehicle because temperature extremes may cause the meter not to work or to be less accurate.

I know how I feel if my blood sugar is high or low so I don’t have to check.

Just as your body changes over time, so may your symptoms for high and low blood sugar. Some symptoms of hyper- and hypoglycemia can be similar so treating incorrectly can lead to serious results. Also, relying on how you feel after treating a low blood sugar may lead to another round of hypoglycemia soon after if the treatment did not raise your level high enough. You should always recheck blood sugar 15 minutes after treating a low to ensure the level is above 70 mg/dL.

Alternate Site Testing

Why consider alternate site testing?

Sore or calloused fingertips

Difficulty obtaining adequate blood sample from fingertips

How accurate are results?

Blood glucose levels from alternate sites may lag behind samples taken from fingertips. This is especially true when glucose levels are changing rapidly such as after exercising or eating, after taking insulin, or with hypoglycemia.

When is alternate site testing appropriate?

Routine testing before meals

At least 2 hours after: eating, exercising, or taking insulin

When is alternate site testing not appropriate?

You think your blood sugar may be low.

Alternate site testing results don’t match your symptoms. Repeat test using fingertips if results don’t match the way you feel.

Testing sooner than 2 hours after a meal, exercising, or taking insulin

You have been diagnosed with hypoglycemia unawareness (no symptoms when your blood sugar is low)

If your meter is not approved for alternate site testing (read manufacturer guide)

If your meter is approved, the lancing device may have a clear cap to use for alternate site testing.

What sites may be used for alternate site testing?

Each meter may have different sites approved for alternate site testing so check the manufacturer’s instructions. Sites may include:

Forearm

Upper arm

Palm

Thigh

Calf

Abdomen

Thumb base

Physical Activity

The U.S. Department of Health and Human Services recommends adults get a minimum of 150 minutes of physical activity per week. This number can be overwhelming if you are just trying to get started. If you don’t know where to start, start small and think outside the normal vision of what counts as exercise. Remember 150 minutes is the ultimate goal but starting with 5-10 minutes a day may feel less overwhelming and may be a safer option if you have not exercised in a while. If you have not had an exercise routine, consult with your healthcare provider to discuss individual guidelines and suggestions for activity. Even if you have been somewhat active, don’t discount the benefit of short bouts of activity if that is all you have time or endurance to complete. Finally, if you dread your workout, consider some of these alternate options to add some fun and variety into your routine:

Revisit your childhood
Play catch, Frisbee, or hopscotch. Create an obstacle course on a playground. Play active video games that make you move more than just your fingers.

Dance!
Take a class or just play your favorite songs at home and make your living room the dance floor.

Do yard work or house work
Kill two birds with one stone. Get your activity minutes in while cleaning inside or outside. Decluttering can also be good for your stress levels once the mess is gone.

Slow it down
Activities like yoga, Pilates, and light weight lifting can be great alternatives for those who don’t love to spend all of their activity minutes doing cardio.

Geocache
Think treasure hunting using GPS. Even if the treasure may only be a logbook to sign to prove you found the cache, this activity can still get you moving without thinking about meeting your activity goal.